Showing papers by "Bertil Forsberg published in 2013"

Air pollution and lung cancer incidence in 17 European cohorts : Prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)

Abstract: Summary Background Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations. Methods This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Eff ects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 μm (PM10), less than 2·5 μm (PM2·5), and between 2·5 and 10 μm (PMcoarse), soot (PM2·5absorbance), nitrogen oxides, and two traffi c indicators. We used Cox regression models with adjustment for potential confounders for cohort-specifi c analyses and random eff ects models for meta-analyses. Findings The 312 944 cohort members contributed 4 013 131 person-years at risk. During follow-up (mean 12·8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically signifi cant association between risk for lung cancer and PM10 (hazard ratio [HR] 1·22 [95% CI 1·03–1·45] per 10 μg/m³). For PM2·5 the HR was 1·18 (0·96–1·46) per 5 μg/m³. The same increments of PM10 and PM2·5 were associated with HRs for adenocarcinomas of the lung of 1·51 (1·10–2·08) and 1·55 (1·05–2·29), respectively. An increase in road traffi c of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1·09 (0·99–1·21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1·01 [0·95–1·07] per 20 μg/m³) or traffi c intensity on the nearest street (HR 1·00 [0·97–1·04] per 5000 vehicles per day).

Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network)

Abstract: Recent epidemiological research suggests that near road traffic-related pollution may cause chronic disease, as well as exacerbation of related pathologies, implying that the entire "chronic disease progression" should be attributed to air pollution, no matter what the proximate cause was. We estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. We then expanded our approach to include coronary heart diseases in adults. Derivation of attributable cases required combining concentration-response function between exposures and the respective health outcome of interest (obtained from published literature), an estimate of the distribution of selected exposures in the target population, and information about the frequency of the assessed morbidities. Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma is assumed, 15% of all episodes of asthma symptoms were attributable to air pollution. Without this assumption, only 2% of asthma symptoms were attributable to air pollution. Similar patterns were found for coronary heart diseases in older adults. Pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbations in European urban areas.

Factors increasing vulnerability to health effects before, during and after floods.

Abstract: Identifying the risk factors for morbidity and mortality effects pre-, during and post-flood may aid the appropriate targeting of flood-related adverse health prevention strategies. We conducted a systematic PubMed search to identify studies examining risk factors for health effects of precipitation-related floods, among Organisation for Economic Co-Operation and Development (OECD) member countries. Research identifying flood-related morbidity and mortality risk factors is limited and primarily examines demographic characteristics such as age and gender. During floods, females, elderly and children appear to be at greater risk of psychological and physical health effects, while males between 10 to 29 years may be at greater risk of mortality. Post-flood, those over 65 years and males are at increased risk of physical health effects, while females appear at greater risk of psychological health effects. Other risk factors include previous flood experiences, greater flood depth or flood trauma, existing illnesses, medication interruption, and low education or socio-economic status. Tailoring messages to high-risk groups may increase their effectiveness. Target populations differ for morbidity and mortality effects, and differ pre-, during, and post-flood. Additional research is required to identify the risk factors associated with pre- and post-flood mortality and post-flood morbidity, preferably using prospective cohort studies.

Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden

Abstract: A changing climate is increasing the frequency, intensity, duration and spatial extent of heat waves. These changes are associated with increased human mortality during heat extremes. At the other ...

Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network)

Abstract: Recent epidemiological research suggests that near road traffic-related pollution may cause chronic disease, as well as exacerbate related pathologies, implying that the entire "chronic disease progression" should be attributed to air pollution, no matter what the proximate cause was. We estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. We then expanded our approach to include coronary heart diseases in adults.Derivation of attributable cases required combining concentration-response function (CRF) between exposures and the respective health outcome of interest (obtained from published literature), an estimate of the distribution of selected exposures in the target population, and information about the frequency of the assessed morbidities.Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma is assumed, 15% of all episodes of asthma symptoms were attributable to air pollution. Without this assumption, only 2% of asthma symptoms were attributable to air pollution. Similar patterns were found for coronary heart diseases in older adults.Pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbation in European urban areas.

Air pollution exposure in early pregnancy and adverse pregnancy outcomes : a register-based cohort study

Abstract: Objectives: Our aim was to study the possible associations between exposure to elevated levels of air pollution, ozone (O-3) and vehicle exhaust (NOx), during early gestation, and adverse pregnancy ...

Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

Abstract: BACKGROUND AND OBJECTIVE: To date, a limited number of population-based studies have prospectively evaluated the remission of childhood asthma. This work was intended to study the remission and per ...

Impact of climate change on ozone-related mortality and morbidity in Europe

Abstract: Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level o ...

Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA(2)LEN study.

Abstract: BACKGROUND: Specific IgE to Staphylococcus aureus enterotoxins (SE-IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for seru ...

Acute Fatal Effects of Short-Lasting Extreme Temperatures in Stockholm, Sweden : Evidence Across a Century of Change.

Abstract: BACKGROUND: Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly d ...

Occupational exposure and new-onset asthma in a population-based study in Northern Europe (RHINE).

Abstract: Objectives: In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. Methods: The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 1989–1992 and again 1999–2001. Asthma was defined as ‘Asthma diagnosed by a physician’ with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 1980–2000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Results: During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR = 3.6; 95% CI [confidence interval] = 1.4–9.0), epoxy (HR = 2.4; 95% CI = 1.3–4.5), diisocyanates (HR = 2.1; 95% CI = 1.2–3.7) and accidental peak exposures to irritants (HR = 2.4; 95% CI = 1.3–4.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR = 3.3; 95% CI = 1.4–7.5), epoxy compounds (HR = 3.6; 95% CI = 1.6–7.9), diisocyanates and accidental peak exposures to irritants (HR = 3.0; 95% CI = 1.2–7.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. Conclusions: This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.

Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population : results from the GA (2) LEN survey

Abstract: BACKGROUND: Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors ...

Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment

Abstract: Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a l ...

Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavík, Iceland 2003-2009

Abstract: Background: Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland’s capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area. Methods: We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 – 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines. Results: Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10. Conclusions: We found an increase in daily emergency hospital visits associated with O3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.

Higher Risk of Wheeze in Female than Male Smokers. Results from the Swedish GA2LEN Study

Abstract: Background: Women who smoke have higher risk of lung function impairment, COPD and lung cancer than smoking men. An influence of sex hormones has been demonstrated, but the mechanisms are unclear a ...

Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses.

Abstract: Background: The River Gota Alv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation. Methods: We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Gota Alv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens. Results: The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns. Conclusion: An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.

Volcanic Ash and Daily Mortality in Sweden after the Icelandic Volcano Eruption of May 2011

Abstract: In the aftermath of the Icelandic volcano Grimsvotn's eruption on 21 May 2011, volcanic ash reached Northern Europe. Elevated levels of ambient particles (PM) were registered in mid Sweden. The aim of the present study was to investigate if the Grimsvotn eruption had an effect on mortality in Sweden. Based on PM measurements at 16 sites across Sweden, data were classified into an ash exposed data set (Ash area) and an unexposed data set (No ash area). Data on daily all-cause mortality were obtained from Statistics Sweden for the time period 1 April through 31 July 2011. Mortality ratios were calculated as the ratio between the daily number of deaths in the Ash area and the No ash area. The exposure period was defined as the week following the days with elevated particle concentrations, namely 24 May through 31 May. The control period was defined as 1 April through 23 May and 1 June through 31 July. There was no absolute increase in mortality during the exposure period. However, during the exposure period the mean mortality ratio was 2.42 compared with 2.17 during the control period, implying a relatively higher number of deaths in the Ash area than in the No ash area. The differences in ratios were mostly due to a single day, 31 May, and were not statistically significant when tested with a Mann-Whitney non-parametric test (p > 0.3). The statistical power was

Air pollution episodes in Stockholm regional background air due to sources in Europe and their effects on human population

Abstract: Using air quality measurements, we categorized air pollution according to source sectors in a rural background environment in southern Sweden based on hourly air-mass backward trajectories during 1 ...

Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood: A Registry Based Analysis of First Born Children and a Sibling Pair Analysis

Abstract: Background: It has been proposed that maternal obesity during pregnancy may increase the risk that the child developsallergic disease and asthma, although the mechanisms underpinning this relations ...

Quality of life in relation to the traffic indicators NO2 and NOx: Results from the Swedish GA2LEN survey

Abstract: Background Worsening of asthma has been found associated with traffic pollution indicators. Aims The aim of the study was to evaluate the impact of traffic pollution on quality of life in asthmatic subjects, individuals with CRS, and controls. Methods Within the Swedish GA2LEN Study, 605 asthmatics with and without CRS, 110 individuals with CRS only and 226 controls were surveyed. The mini Asthma Quality of life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test, exhaled nitric oxide, smell test and peak nasal inspiratory flow were used. Air pollution levels at the home address were modeled using dispersion models. Results Levels of NO2 (mean 10 microg/m3) and NOx (14 microg/m3, IQR 8.7-70) were similar among groups (controls, asthmatics, individuals with CRS, and asthmatics with CRS). The mAQLQ overall score was not found associated with NO2 or NOx, with or without adjustments, and neither was scores within each of the four domains of mAQLQ: symptoms, activity limitations, emotional functions, and effects of environmental stimuli. The mean EQ-5D index value, based on the five dimensions mobility, self-care, usual activities, pain/discomfort and anxiety depression, was also found unrelated to NO2 and NOx. Stratification by condition did not reveal any differences in NO2 or NOx related effects. Conclusions Within these exposure levels, NO2 and NOx appear not to affect quality of life among controls, asthmatics, individuals with CRS, or asthmatics with CRS. This could perhaps be explained by selection bias related to susceptibility (avoidance), moderate exposure levels or confounders related to the type of residential area.

Air pollution and children's health in Sweden: an enquiry into how the economic benefit of improvements in children's health resulting from reductions in air pollution can be assessed

Abstract: Clean air is one of 16 Environmental Objectives adopted by the Swedish parliament to guide action towards a sustainable environment. This project is part of the work undertaken by the Swedish Environment Protection Agency (Swedish EPA) to bring about the fulfilment of this goal. Much research has been undertaken regarding air pollution and health impacts in the adult population but much less is known about how pollutants influence children's health. The overriding purpose of this study has therefore been to see how and to what extent the economic benefit from reducing these impacts can be calculated. To answer this question we provide a brief introduction on the method commonly used to do these kinds of benefit calculations. Two crucial inputs into these calculations are estimates of the health impacts and estimates of the economic values for the health impacts. We therefore start by providing a summary of the current state-of-art regarding these inputs which is based on a survey of the literature in each area. We then perform two case studies that describe how these economic benefits can be calculated and what influences the results. The calculation is based on the findings in the literature reviews and we also describe the exposure assessment that is another crucial input into these calculations.

Traffic air pollution and prevalence of respiratory symptoms

Abstract: Background : Little is known of potential sex differences in associations between traffic air pollution and respiratory symptoms in adults. Aims : To examine how exposure to traffic pollution is associated with prevalence of respiratory symptoms in men and women. Methods : As part of the Respiratory Health In Northern Europe (RHINE) study, 12319 subjects 38-65 yrs answered questionnaires on risk exposures and respiratory symptoms in 2010-12. We performed logistic regression using bedroom near a road with moderate/much traffic as proxy for traffic air pollution exposure. Outcomes were respiratory symptoms (chest tightness, long-term cough, cough with phlegm, wheeze, asthma attacks and nocturnal dyspnea attacks). Analyses were adjusted for study centre, age, smoking and education level. Results : 10% lived near a busy road. Symptom prevalence varied from 4% asthma attacks to 19% wheeze. Subjects who lived near busy roads had 1.2-1.9 times higher adjusted odds ratio for respiratory symptoms than unexposed subjects. Traffic exposure was associated with chest tightness, wheeze and nocturnal dyspnea attacks for both sexes (p<0.05), and also with phlegm cough and asthma attacks for women (p<0.05). View this table: Adjusted ORs (95%CI) for respiratory symptoms, subjects with bedroom near road with traffic. Conclusions: Living close to a busy road was associated with increased prevalences of respiratory symptoms in both sexes, but associations were found for more symptoms among women than men.